Frequently Asked Questions

Henry Schein Sleep Complete

Q: Why do I need the Sleep Complete program?
A: After market research was completed, it became evident that the availability of what was needed by the dentist was very fragmented. The Sleep Complete program was designed to provide you with all of the education, training and products necessary to implement a successful dental sleep medicine program in their practice.

Q: Why would I be more likely to discover a patient’s potential sleep disorder than a physician?
A: Patients usually visit the physician only when something is bothering them, while dental patients often visit their dentist on a regularly scheduled appointment twice each year. During that time, there is ample opportunity to talk to the patient and even add a few simple questions regarding sleeping habits to the medical history.

Q: What kind of questions should I or my team ask the patient in regards to their sleeping habits?
A: For example;

Do you snore or have you been told that you snore?

Do you ever wake-up in the middle of the night gasping for air?

Have you ever been diagnosed with sleep apnea?

Q: Does every patient who snores have sleep apnea?
A: No. Snoring is a symptom of sleep apnea, but is not a direct indicator. In order to determine whether the patient has sleep apnea (a medical condition) or just snoring (a non-medical condition) the patient needs to be referred for an overnight sleep study.

Q: Why can’t a dentist diagnose sleep apnea?
A: Sleep apnea is a medical condition and its diagnosis is outside the scope of the dental practice.

Q: What if I just treat the patient for snoring. Won’t that solve the problem even if it is sleep apnea?
A: Without the appropriate diagnosis, you would not know whether you are dealing with snoring or sleep apnea. Once it has been determined that the patient is only suffering from snoring, you can fabricate an appropriate snoring appliance for the patient.

Q: If the patient is diagnosed with snoring, can the snoring appliance be billed through the patient’s medical or dental insurance?
A: Unfortunately, there is no insurance coverage for a snoring appliance through either medical or dental insurance. This is due to snoring not being considered a medical condition

Q: Why do I need to attend a two-day training program?
A: Implementing a dental sleep medicine program involves a great deal of new knowledge, as well as, hands-on training. We have found there are huge pieces of missing data that we cannot possibly fit into a shorter presentation and this will prevent the office from implementing a successful program.

Q: Why is it important to have my office team members at the two-day seminar?
A: The team members are vitally important to the overall success of the dental sleep medicine program within any office. Our two-day training program is unique in that at different times during the two-days, we break-out the team members from the dentists. In this way, the team can be receiving the kind of hands-on training they need to appropriately bill medical insurance, etc. while you are learning the clinical aspects.

Q: Can we attend just one day of the two-day program?
A: You can, but we do not encourage it. There is just too much to miss on the second day that actually helps bring the pieces from the first day together into a proper implementation within the dental practice.

Q: What is the cost of the two-day training program?
A: Currently, the price of the program is $1,795.99 which includes the dentist and up to two team members. The course also provides 16 CE credits for each member, but most importantly, the dentist and team can walk out of the program with the education and training necessary to implement a dental sleep program within their practice, immediately. There is also a separate price for the dentist ($995) and additional team members ($495).

Q: Where and when can I attend a Sleep Complete Two-Day Seminar?
A: The full schedule of seminars is listed here on our Education Programs page. Click Here

Q: Do you offer any other educational opportunities to learn about Dental Sleep Medicine?
A: We offer a FREE, one-hour webinar program on the 3rd Wednesday of each month at 8:00pm (EST). You can register for our next LIVE program or take one of our archived programs by going to www.totalhealthlearning.com.

In addition, we have implemented a Sleep Complete Phase II program entitled, “Saving Lives and Growing Your Practice through Dental Sleep Medicine-Continuing the Journey”. This two-day program is designed for the dentist and all team members desiring to intensify and broaden their understanding of Dental Sleep Medicine. Dentists and their team can join Dr. John Tucker to continue their Dental Sleep Medicine Journey with this exciting, hands-on experience! Here are the dates in 2014:

Oral Appliance Therapy

Q: What is the difference between other devices and the Sleep Complete range of appliances (The Moses®, The EMA Custom™ and The EMA First Step™)?
A: There are currently over a hundred appliances commercially available for the Dentist all with varying degrees of comfort and efficacy. We have assembled a group of devices that address the majority of patients’ needs. The theme we have adopted for maximum efficacy with our product suite is “creating room for the tongue, mandibular advancement, adjustability, patient comfort and compliance.”

Q: Are the Sleep Complete range of appliances FDA Cleared?
A: Yes all of our oral appliances, The Moses and EMA, are FDA cleared for the treatment of Snoring and Sleep Apnea.

Q: Are there any clinical research papers available for our product suite of appliances?
A: Yes, studies have been presented to the FDA to substantiate efficacy of The Moses® and EMA™ appliances. Published articles are available.

Q: Once I have used my oral appliance vouchers from their Sleep Complete package (3 Moses, 3 EMA’s & 3 EMA First Step Kits) how do I order subsequent appliances?
A: Simply send in the patient’s impressions and a bite registration to a Modern Dental Laboratory USA service center along with an RX form requesting the device of choice. You will be billed for that product through Henry Schein.

Q: Can children wear oral appliances for the treatment of snoring and sleep apnea?
A: No, you do not want to place a rigid appliance over growing maxillary and mandibular arches. There are other considerations when looking at children who snore or have suspected apnea like adenoids, tonsils, myofunctional habits and orthopedic development. When you treat sleep disordered breathing in children by early orthodontics, especially palatal expansion, this may have the potential to circumvent future airway issues later in life.

Q: Do oral appliances cause Temporomandibular Disorders (TMD)?
A: Oral appliance therapy does not cause TMD. It is often reported that sleep apnea patients who have experienced TMD discomfort prior to therapy, have found that their symptoms have improved by wearing an oral appliance. There are occasional cases where oral sleep appliances cause discomfort in TMD patients but this is reversible by the dentist telling the patient not to wear the device if it is causing discomfort in their joints.

Q: Can edentulous and partially edentulous patients wear oral appliances?
A: Oral sleep appliances work best with edentulous patients who have implant retained full or removable dentures. In many instances oral sleep appliances can be made to fit over conventional full or partial dentures. With fully edentulous patients (in particular the lower arch), retention needs to be very secure however. Tongue retaining devices can also be considered an option for edentulous patients.

Q: What if your patient complains that their bite feels “strange” in the morning?
A: This occurs occasionally in some patients but function should be restored within an hour after taking the appliance out. It is primarily due to the facial muscles adapting well to the vertical dimension and the anterior posterior relationship. Specifically for the Moses® appliance, the patient can be instructed to remove the lower component and chew on the upper component for 10-15 minutes. If after breakfast, their bite still feels “strange”, the patient can chew a piece of sugarless gum for 10-15 minutes.

The Moses® Oral Appliance

Q: How do I take the bite for a Moses®?
A: The registration must be taken with the “Moses Bite Shims” inside the mouth so the lips can be comfortably closed with nothing extruding from the lips. By having the lips closed this will facilitate nasal breathing which is the best way for humans to breath. The initial bite registration should be the greatest vertical height at which the patients can comfortably keep their lips closed combined with the maximum protrusive position that is comfortable for the patient to attain.

Q: Where do I order the Bite Shims and Blue Bite Material?
A: From your local Henry Schein Field Sales Consultant

Q: Must the patient wear the maxillary piece?
A: Yes, the patient must wear the flexible maxillary component to prevent tooth movement and provide stability within the maxillary arch. If the upper component is not worn teeth may move from both tongue and protrusive mandibular pressure.

Q: Is the Moses appliance adjustable (Titratable)?
A: Yes, there are jack screws on both sides of the appliance and are to be utilized by the Dentist (in most cases) to attain the amount of mandibular advancement or titration needed for patient efficacy. A conservative starting point is an advantage for patient comfort.

Q: How do you adjust the screws?
A: A small “key” or “wrench” is sent to the Dentist with each Moses® appliance along with an instruction booklet

Q: Will the Moses arrive pre-adjusted for the patient?
A: The jaw relationship established by the Dentists bite registration will be the exact jaw position that the Moses® appliance will be fabricated. They are able to titrate the device, back and forth, by activating the screw mechanism with the key provided (1 turn = 1/8 of mm). The screw has a 6mm thread. You cannot wind the screw back from the initial starting position, so the Dentist needs to be conservative when taking the protrusive bite record.

Q: Who will decide the vertical dimension (VD) of the appliance?
A: The laboratory will manufacture the appliance to the vertical height of the bite registration you provide, while creating maximum opening and space for the tongue. It is important that you follow the Moses Bite Registration protocol.

Q:Is it possible to make minor adjustments to the appliance?
A: Yes, small acrylic modifications and relines are able to be made with the Moses® device.

Q: Will the lower anterior teeth flare forward as they have no acrylic incisal coverage?
A: No they will not. This is due to the design of the Moses® appliance and the bite registration protocol. It encourages good lip seal which allows the force of the lower lip to prevent the lower anteriors from flaring forward.

Q: Does The Moses® come with a warranty?
A.Modern Dental Laboratory USA offers a 2 year warranty on all Removable products. This includes The Moses®

MicroMD® for the Dental Practice

Q. We are starting to bill medical insurance from our dental office. What is our first step?
A. Here are the key elements for medical billing that can be managed through MicroMD EMR (Electronic Medical Record) software.

ICD diagnostic codes showing the condition, disease or problem are needed to connect the patient’s condition or symptom to diagnosis codes

CPT procedure codes to report your services.

Written SOAP reports of medical necessity

Medical claim form printing and electronic billing (CMS 1500).

Q. Can claims be sent electronically from MicroMD for the Dental Practice?A. Yes, sending electronic claims through a MicroMD preferred clearinghouse is the most efficient way to send claims. Electronic billing results in quicker payments and eliminates mountains of paperwork. With electronic billing in place, practices can verify eligibility, track claims and receive electronic remittance of payments to autopost into MicroMD to better manage cashflow and financial reporting.

Q. Do I have to have Microsoft Word running on in order for MicroMD for the Dental Practice to work?A. If a practice desires to utilize forms and letters within MicroMD PM for communications (collection letters, etc), Microsoft Word would need to be installed on the workstation running MicroMD PM.

Q. Can I run MicroMD for the Dental Practice on a MAC or IPad?A. MicroMD is not a native MAC or iPad application, although users accessing their MicroMD software through the cloud will be able to utilize selected areas of the software without any scrolling or window resizing via the web on an iPad.

Q. Is there an annual support cost for MicroMD for the Dental Practice?A. All of the annual support costs are built-in to the price of MicroMD for the Dental Practice. No separate billing and multiple invoices. One package, one price.

Q. Can we install MicroMD for the Dental Practice on multiple workstations?
A. Yes, MicroMD can be installed on any server and workstations with a Microsoft SQL license.

Q. How is training provided for MicroMD for the Dental Practice?
A. Web-based training will be included in your “All In” package. Product documentation, reference materials and self-help videos will also be available for post-training education.

Q. What are the minimum system requirements to run MicroMD Software on the server?
A. Your MicroMD sales rep can provide the most current hardware and software requirements needed to for MicroMD software to run optimally along with any other office software.

WatchPAT200 Portable Sleep Monitoring Device

Q. When is it worn and where is it worn?A. Itamar Medical’s WatchPAT is only worn with probes on two (2) fingers when sleeping. The simplicity of the WatchPAT200 offers the patient and practitioner the most reliable home sleep testing (HST) device in the market with a failure rate of less than 2%.

Q. What is Peripheral Arterial Tone (PAT)?A. PAT is a physiological signal that mirrors changes in the autonomic nervous system caused by respiratory disturbances during sleep. The PAT signal is automatically analyzed utilizing a clinically validated algorithm along with heart rate, and oxygen saturation to identify respiratory events. Using specific signal patterns, the algorithm provides two indices used in determining the degree of sleep apnea – Apnea-Hypopnea Index (AHI) and Respiratory Disturbance Index (RDI).

Q. How does the PAT pick up apnea, hypopnea & RERA events?A. Watch PAT utilizes Peripheral Arterial Tone (PAT), a physiological signal that mirrors changes in the autonomic nervous system caused by respiratory disturbances during sleep. The automatic algorithm of the WatchPAT analyzes the PAT signal amplitude along with the heart rate, and oxygen saturation to identify respiratory events. Using specific signal patterns, the algorithm provides two indices – AHI & RDI. The snore sensor enables the clinician to determine if the respiratory events are obstructive and the body position sensor enables the clinician to determine if there is a positional component to the sleep apnea.

Q. Why is the PAT probe inflated?
A. The probe is inflated in order to clamp it on the finger and apply a uniformed pressure field around the finger that is required for an accurate measurement of the PAT signal.

Q. Can I re-use the PAT probe?
A. NO! The probe is one time use only and once it is applied on the finger it can’t be re-used. Once inflated the probe loses its ability to maintain the elasticity properties of the inner membrane, which are necessary for an accurate measurement of the PAT signal. In addition the PAT probe can’t be sterilized (the very fine membrane will be damaged).

Q. How does the WatchPAT detect sleep and wake?
A. The sleep/wake detection is based on data recorded by the built in actigraph and the specific signal patterns associated with the PAT signal. The propriety software zzzPAT automatic actigraph algorithm discriminates between sleep and wake states in normal subjects and OSA patients. WatchPAT’s sleep/wake algorithm has been validated and published in peer-reviewed journals showing close agreement with PSG of 86% in normal subjects, 86%-mild OSA, 84%-moderate OSA, 80% severe OSA (.Hedner J, Pillar G, Pittman DS, Zou D, Grote L, White D. A Novel adaptive wrist actigraphy algorithm for sleep-wake assessment in sleep apnea patients. SLEEP, 2004, 27(8):1560-6.)

Q. How do the WatchPAT and zzzPAT detect REM?
A. REM sleep is associated with considerable attenuation of the PAT signal coupled with specific variations in the PAT amplitude and rate. Based on this specific variability in the PAT and pulse rate signals, REM sleep stage differs from no-REM sleep. In addition, it is differentiated from the wake state by the advanced actigraphy algorithms of the WP.

Q. Are there published studies that clinically validate the WatchPAT technology?A. The WatchPAT has been scientifically validated more than any ambulatory sleep diagnostic device currently or previously available (~40 peer-reviewed articles) based on over 3,000 PSG studies simultaneously with WatchPAT. More than 230,000 tests have been performed worldwide using WatchPAT. Regarding long-term, multi-centered controlled studies, it is one of only 2 devices approved by Blue Cross’ California Technology Assessment Forum as “improving health outcomes.”

Q. Why is it an advantage to use sleep time vs. study time?A. One of the biggest problems with HST devices is the lack of real sleep monitoring providing only total study time in which case the respiratory disturbances index is calculated by dividing the total number of respiratory events to what might be a substantial longer time period and thus providing a lower RDI (or AHI) than the real one. The actual sleep time is essential to determine the true RDI/AHI. The WatchPAT detects sleep/wake state and REM sleep stage along with total sleep time to minimize the number of potential false negatives.

Q. Who can interpret an HST?A. In order for therapy to be reimbursed, most insurance payors, including Medicare (CMS), require that the HST is interpreted by a licensed medical doctor who is board certified or board eligible (awaiting examination) in sleep medicine. Alternatively, a physician that sits on the physician panel of an American Academy of Sleep Medicine (AASM) and/or JCAHO accredited sleep center may interpret an HST.

Q. Is there a warranty?A. Yes. The WatchPAT offers a one year warranty against manufacturing defects, which means you can have full confidence in the product. Each additional year is $425.

Q. Are there any exclusion criteria for the using the WatchPAT?A. The exclusion criteria for using the WP include:

Age less than 17 years old.

Using one of the following medications:

Alpha blockers (if taken less than 24 hours before the study).

Short acting nitrates (less than 3 hours before the study).

Permanent pacemaker.

Q. What are the costs to conduct a home sleep study (HST) using the WatchPAT200?A. The cost to conduct a study are $50 for a probe, $1.50 for adhesives, and the capital depreciation costs that approximate $15 per study for a total cost of approximately $66.50 per study.